Meta-analysis: mistake or milestone in medicine?

Foroutan, Farid; Guyatt, Gordon; Alba, Ana Carolina; Ross, Heather J.

doi:10.1136/heartjnl-2018-313042

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…The clinical utility of systematic reviews and meta‐analyses are manifold (Moher, et al, ; Uman, ). They can be used as: (a) educational tools providing a starting point for students, researchers and clinicians striving to become familiar with a new topic, (b) consensus‐building methods to arrive at consolidated knowledge with a new clinical challenge, (c) ways to shed light on a gap in the literature, (d) a reference point for comparing future individual studies, and (e) priors for future more targeted analyses, alleviating the curse of dimensionality that is ever‐so‐prevalent in neuroimaging (Fiest, Pringsheim, Patten, Svenson, & Jette, ; Foroutan, Guyatt, Alba, & Ross, ; Gopalakrishnan & Ganeshkumar, ; Sheehan & Lam, ).…”

Section: Introductionmentioning

confidence: 99%

Practical recommendations to conduct a neuroimaging meta‐analysis for neuropsychiatric disorders

Tahmasian

Sepehry

Samea

et al. 2019

Human Brain Mapping

137

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Over the past decades, neuroimaging has become widely used to investigate structural and functional brain abnormality in neuropsychiatric disorders. The results of individual neuroimaging studies, however, are frequently inconsistent due to small and heterogeneous samples, analytical flexibility, and publication bias toward positive findings. To consolidate the emergent findings toward clinically useful insight, meta‐analyses have been developed to integrate the results of studies and identify areas that are consistently involved in pathophysiology of particular neuropsychiatric disorders. However, it should be considered that the results of meta‐analyses could also be divergent due to heterogeneity in search strategy, selection criteria, imaging modalities, behavioral tasks, number of experiments, data organization methods, and statistical analysis with different multiple comparison thresholds. Following an introduction to the problem and the concepts of quantitative summaries of neuroimaging findings, we propose practical recommendations for clinicians and researchers for conducting transparent and methodologically sound neuroimaging meta‐analyses. This should help to consolidate the search for convergent regional brain abnormality in neuropsychiatric disorders.

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Section: Introductionmentioning

confidence: 99%

Practical recommendations to conduct a neuroimaging meta‐analysis for neuropsychiatric disorders

Tahmasian

Sepehry

Samea

et al. 2019

Human Brain Mapping

137

View full text Add to dashboard Cite

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“…In contrast, Cho et al (33) showed higher level of evidence for adhesiolysis, than spinal cord stimulation. The reasons for discordant results may relate to a lack of understanding of the procedure, lack of understanding of principles of EBM with importance of utilization of clinical expertise, and finally confluence of interest (16,(45)(46)(47)(48)(49)(50).…”

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confidence: 99%

Effectiveness of Percutaneous Adhesiolysis in Post Lumbar Surgery Syndrome: A Systematic Analysis of Findings of Systematic Reviews

Manchikant

2019

Pain Phys

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Background: Post lumbar surgery syndrome is common and often results in chronic, persistent pain and disability, which can lead to multiple interventions. After failure of conservative treatment, either surgical treatment or a nonsurgical modality of treatment such as epidural injections, percutaneous adhesiolysis are often contemplated in managing post lumbar surgery syndrome. Multiple previous systematic reviews have reached discordant conclusions about the level of evidence for the effectiveness of percutaneous adhesiolysis in managing post lumbar surgery syndrome and other conditions. Study Design: A systematic review of previously published systematic reviews assessing efficacy of percutaneous adhesiolysis in managing post lumbar surgery syndrome. Objective: To evaluate the value and validity of previous systematic reviews performed after 2015 on effectiveness of percutaneous adhesiolysis in managing chronic refractory low back and lower extremity pain secondary to post lumbar surgery syndrome. Methods: Previous systematic reviews on percutaneous adhesiolysis were evaluated. The quality of each systematic review was assessed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A Measurement Tool to Assess Systematic Reviews (AMSTAR). The randomized trials included in the available systematic reviews were assessed by Cochrane review criteria and Interventional Pain Management techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for methodologic quality. Data sources included relevant systematic reviews and the randomized trials included in those systematic reviews published since 2015 with searches of PubMed, Cochrane reviews, and Google Scholar through February 2019. Outcome Measures: Outcome measures were significant improvement defined as 50% pain relief and improvement in functional status. Short-term efficacy was defined as improvement of 6 months or less, whereas long-term efficacy was defined as more than 6 months. Results: Three systematic reviews and 4 randomized controlled trials (RCTs) of post lumbar surgery syndrome with chronic refractory low back and lower extremity pain showed notable evidence of significant pain relief. Only one systematic review, which was of low quality with inappropriate analysis, showed lack of evidence. Conclusion: Overall, the present analysis shows Level I evidence for percutaneous adhesiolysis based on significant evidence from published RCTs and 3 of the 4 systematic reviews. Key words: Post lumbar surgery syndrome, epidural fibrosis, percutaneous adhesiolysis, systematic reviews, randomized controlled trials

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“…The dramatic changes with decline and utilization of percutaneous adhesiolysis have been attributed to the philosophical approach of the Affordable Care Act (ACA), misunderstanding of evidence-based medicine (EBM), and multiple other regulations (49,53,63,64,(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97). Further factors included noncoverage by a multitude of insurers related to lack of local coverage determinations (LCDs) and LCDs without coverage, followed by reduced reimbursement (98,99).…”

Section: Discussionmentioning

confidence: 99%

Declining Utilization Patterns of Percutaneous Adhesiolysis Procedures in the Fee-For-Service (FFS) Medicare Population

et al. 2020

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BACKGROUND: Percutaneous epidural adhesiolysis is a minimally invasive therapeutic modality used in the treatment of patients with chronic low back and lower extremity pain, often recalcitrant to other modalities including epidural injections and surgical interventions. While the initial utilization since its introduction and development of appropriate Current Procedural Terminology (CPT) codes increased up until 2008, but since 2009, there has been a significant decline in utilization of these procedures in the Medicare population. These procedures declined by 53.2% at an annual rate of 10.3% from 2009 to 2016. A recent update analysis on the reversal and decline of growth of utilization of interventional techniques in managing chronic pain in the Medicare population from 2009 to 2018 revealed an even further decline of adhesiolysis procedures. STUDY DESIGN: An analysis of the utilization patterns of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain in the Medicare population from 2000 to 2018, with comparative analysis from 2000 to 2009 and 2009 to 2018. OBJECTIVE: To assess the utilization patterns of percutaneous adhesiolysis in managing chronic low back pain in the Medicare population. METHODS: The Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master of Fee-For-Service (FFS) Data from 2000 to 2018 was used. In this analysis, various variables were assessed in reference to usage patterns of percutaneous adhesiolysis procedures with analysis of growth or declining utilization patterns. We also assessed specialty-based utilization, as well as statewide utilization. RESULTS: The decline of percutaneous adhesiolysis procedures began in 2009 and has continued since then. From 2009 to 2018, the overall decline was 69.2%, with an annual decline of 12.3% compared to an overall 62.6% increase from 2000 to 2009, with an annual increase of 5.6%. Compared to multiple other interventions, including epidural injections and facet joint interventions, percutaneous adhesiolysis has declined at a rapid rate. CONCLUSIONS: This assessment in the FFS Medicare population in the United States shows an irreversible decline of utilization of percutaneous adhesiolysis procedures, which has been gradually deteriorating with a 69.2% decline from 2009 to 2018 with an annual decline of 12.3% during that same time period. KEY WORDS: Epidural injections, percutaneous adhesiolysis, post-surgery syndrome, spinal stenosis, lumbar disc herniation

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Meta-analysis: mistake or milestone in medicine?

Cited by 13 publications

References 14 publications

Practical recommendations to conduct a neuroimaging meta‐analysis for neuropsychiatric disorders

Practical recommendations to conduct a neuroimaging meta‐analysis for neuropsychiatric disorders

Effectiveness of Percutaneous Adhesiolysis in Post Lumbar Surgery Syndrome: A Systematic Analysis of Findings of Systematic Reviews

Declining Utilization Patterns of Percutaneous Adhesiolysis Procedures in the Fee-For-Service (FFS) Medicare Population

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